What is anxiety? Ask anyone to define anxiety and you will quickly realize there is no shortage of examples that people can provide. Although anxiety is a very common human experience, the descriptions that people provide are quite varied.

Anxiety is a human emotion. Everyone experience it. Yet, each person experiences this emotion in unique ways. The following case examples illustrate these various experiences of anxiety:

Sally is a 24-year-old sales associate in a highly prestigious pharmaceutical firm. She constantly works under a great deal of pressure. She says it's "no big deal." She even believes she thrives off this stress. However, she recently walked into her local grocery store and began to sweat. Her heart began to race. She felt like she was losing control. This happened on several occasions. She became so distressed she decided to order her groceries online to avoid another repeat episode.

What are the symptoms of anxiety?

Anxiety can produce physical, behavioral, emotional, cognitive and psychological symptoms. Common physical symptoms include a feeling of restlessness, feeling "keyed up," or "on-edge;", shortness of breath, or a feeling of choking, sweaty palms, a racing heart, muscle tension, nausea, feeling faint or shaky and sleep disturbances.

Behavioral symptoms of anxiety refer to what people do (or don't do) when they are anxious. Typical behavioral responses to anxiety may include avoidance, such as avoiding social situations or taking the stairs instead of an elevator, escaping behaviors, such as excessive drinking or drug use; or limiting the amount and scope of daily behaviors and activities to feel safe.

The thoughts people experience when anxious are commonly referred to as worry. Although the content of the thoughts may vary depending on the person and situation, common themes include "What if _ happens?" or "I can't possibly tolerate not knowing_" or "I am going crazy" or "What's happening to me?"

Psychological symptoms of anxiety may include problems with concentration, or difficulty with staying on task; memory difficulties; and, depressive symptoms such as hopelessness, a lack of energy, and a poor appetite.

What causes anxiety?

The biopsychosocial model suggests that the causes of anxiety can be roughly categorized into three main groups: 1. biological causes, 2. psychological causes, and 3. environmental or social causes.

The biological category refers to the body's physiological, adaptive responses to fear. It also refers to genetic traits, and the brain functioning that we inherit.

The biological model involves 6 systems in the body including the nervous system (including the brain), the cardiovascular, respiratory, digestive, excretory, and endocrine system.

Biological causes also include the "fight or flight" response where when we are in the presence of an immediate danger, our bodies will automatically begin to prepare us to either attack the threat (fight) or to escape from the danger (flight). A person's heart begins to beat very fast and this increased blood flow ensures extra oxygen is delivered to the muscles to prepare for that fighting or flight.

Research has identified four important variables that predict a psychological vulnerability to anxiety. These are perceived control (our ability to control a potentially stressful event), cognitive appraisals (the way we evaluate and assess a particular environmental event or situation), cognitive beliefs (our core beliefs about ourselves, and the world around us), and cognitive distortions (errors we make in our thinking).

Environment refers to our life experiences, particularly social interactions with other people, especially caregivers, family members, etc.

What is a panic attack?

Panic attacks are a specific, common symptom of many anxiety disorders.

Panic attacks are sudden, extreme feelings of fear and/or discomfort lasting for a distinct period of time. This sudden surge peaks in intensity within a few minutes, at which point it begins subside.

There is often a sense of doom and gloom and a powerful desire to escape.

Common symptoms include palpitations and/or pounding heart; sweating; trembling or shaking; chest pain or discomfort; feeling dizzy; numbness or tingling sensations; hot flashes or chills; fear of losing control or "going crazy" or a fear of dying.

Panic attacks are a false alarm that triggers the "fight or flight" response system.

There are 2 types of panic attacks - uncued and cued.

Unexpected, or uncued, panic attacks seem to come from "out of the blue." They do not have an identifiable source that sets them off. It is believed these occur in response to some kind of life stress. They are found in Panic Disorder.

Expected, or cued, panic attacks are attacks with an obvious trigger. They occur when a person is exposed to certain situations or objects where panic attacks have happened before. The onset is sudden and occurs immediately upon exposure to the situation or object.

Cued panic attacks are found in Social Anxiety Disorder, specific Phobias, and agoraphobia.

Panic disorder is characterized by uncued (unexpected) panic attacks.

In order to be diagnosed with Panic Disorder, a person must experience repeated, unexpected (uncued) panic attacks and be followed by constant concerns about having more attacks; worrying about the consequences of the attacks; or significantly changing behavior to avoid the attacks. These worries and concerns about experiencing another attack must continue for a month or longer for a diagnosis of Panic Disorder.

What types of Anxiety Disorders are there?

Separation Anxiety Disorder is characterized by a developmentally inappropriate and excessive fear of becoming separated from a primary attachment figure. For more information about Symptoms and Treatments

Selective Mutism occurs when a child or adult persistently refuses to speak in specific situations where speaking is expected. For more information about Symptoms and Treatments

Agoraphobia is characterized by an intense fear or anxiety that occurs when someone is faced with a situation that is difficult or embarrassing to leave, or where help would be unavailable if they were to experience panic-like symptoms, such as becoming dizzy or disoriented. For more information about Symptoms and Treatments

Specific phobia is the intense fear, anxiety, and avoidance of a specific object or situation, such as flying, heights, getting a shot, or being near animals. For more information about Symptoms and Treatments

Social phobia, or Social Anxiety Disorder, is the intense fear, anxiety, and avoidance of social situations where there is the potential of being negatively judged by others. For more information about Symptoms and Treatments

People with Generalized Anxiety Disorder (GAD) have uncontrollable, excessive anxiety and excessive worry. For more information about Symptoms and Treatments

What types of therapy are generally used to treat Anxiety Disorders?

Anxiety disorders are one of the most treatable psychiatric conditions.

Research consistently finds that cognitive behavioral therapy (CBT) is the most effective treatment strategy for treating a variety of conditions including anxiety disorders.

Supportive psychotherapy (often thought of as "talk therapy") and psychodynamic or psychoanalytic therapy tends to be ineffective for anxiety disorders.

A common type of behavioral therapy used in the treatment of Anxiety Disorders is called exposure and response prevention therapy (ERP). Exposure means facing or confronting one's fears repeatedly until the fear subsides. Response prevention means not engaging in avoidance or escape behaviors when faced with a feared situation.

Acceptance and Commitment Therapy (ACT) recognizes that words (and the thoughts formed with words) have individual and unique meanings. Because language allows us to attribute meaning to thoughts, it is possible for us to allow thoughts to enter our minds without giving them importance. ACT teaches people how to accept their emotional distress.

Dialectical behavior therapy (DBT) teaches participants skills that enable them to: 1) better regulate their intense emotions; 2) become more effective in their interpersonal relationships; 3) improve their ability to cope with emotional crises; and, 4) decrease their reliance on unhealthy coping behaviors such as substance abuse, self-injury, and suicidal behaviors. Dialectical behavior therapy may be beneficial for persons who are reluctant to engage in exposure and response prevention therapy (ERP).

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